Provider Demographics
NPI:1235137597
Name:ZAMMERILLA, WILLIAM ROGER (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROGER
Last Name:ZAMMERILLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 OLD CLAIRTON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-3915
Mailing Address - Country:US
Mailing Address - Phone:412-653-1115
Mailing Address - Fax:412-653-5337
Practice Address - Street 1:76 OLD CLAIRTON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-3915
Practice Address - Country:US
Practice Address - Phone:412-653-1115
Practice Address - Fax:412-653-5337
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
PA026843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA479285OtherUNITED CONCORIDA CO. INC